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Making evidence fit for purpose in decision making: a case study of the hospital discharge of older people
- Authors:
- GLASBY Jon, WALSHE Kieran, HARVEY Gill
- Journal article citation:
- Evidence and Policy, 3(3), August 2007, pp.425-437.
- Publisher:
- Policy Press
This article focusing on a case study topic (hospital discharge), participants were provided with six sources of evidence chosen to illustrate six very different approaches to generating valid knowledge. Participants then explored a series of questions about each (including reliability/validity, key limitations and contributions to new knowledge). Overall, none of the sources was felt to offer a definitive insight into the issue at stake. A key challenge, therefore, is to design deliberative processes to synthesise and integrate evidence of different types and from multiple sources.
How 'they' decide: exploring professional decision-making
- Authors:
- McKEGANEY Neil, MacPHERSON Isobel, HUNTER David J.
- Journal article citation:
- Research Policy and Planning, 6(1), 1988, pp.15-19.
- Publisher:
- Social Services Research Group
Considers advantages and disadvantages of employing observational and interviewing techniques - illustrated by a study of the assessment of elderly people for admission to residential care.
Older people as research colleagues
- Author:
- BRIGHT Les, GREEN Bert
- Journal article citation:
- Working with Older People, 7(4), December 2003, pp.14-16.
- Publisher:
- Emerald
Describes how, in a three-year research project, Housing Decisions in Old Age, between the charity Counsel and Care and Lancaster's University's Department of Applied Social Science, the researchers established from the outset the principle of involving older people. Their view being that the findings would be enriched by being more reflective of, and responsive to,the concerns of older people.
The Interview for Decisional Abilities (IDA): a tool to assess the decisional capacity of abused and neglected older adults
- Authors:
- ABRAMS Robert C., et al
- Journal article citation:
- Journal of Elder Abuse and Neglect, 31(3), 2019, pp.244-254.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article presents the Interview for Decisional Abilities (IDA), a semi-structured tool for use by adult protective services (APS) workers as part of their comprehensive assessments of clients. The IDA was created in response to a Federal mandate to standardise the procedures and competencies of APS agencies with a view to improving client assessments and facilitating cross-jurisdictional research on adult mistreatment. The proximal aim of the IDA is to guide workers in gathering information on the ability of suspected victims of adult mistreatment to make decisions about the risks they face. (Edited publisher abstract)
Improving choice at end of life: a descriptive analysis of the impact and costs of the Marie Curie delivering choice programme in Lincolnshire
- Authors:
- ADDICOTT Rachael, DEWAR Steve
- Publisher:
- King's Fund
- Publication year:
- 2008
- Pagination:
- 45p.
- Place of publication:
- London
This is a descriptive analysis of the impact and costs of new services as part of the Marie Curie Delivering Choice Programme, which was launched in 2004. Palliative care is an increasing policy concern. Although the majority of people report that they would choose to die in their home, only a minority of patients achieve this wish. The Delivering Choice Programme aims to develop and help provide the best possible service for patients at the end of their lives.
Decision-making capacity of elderly patients assessed through the vignette method: imagination or reality?
- Authors:
- VELLINGA A., et al
- Journal article citation:
- Aging and Mental Health, 9(1), January 2005, pp.40-48.
- Publisher:
- Taylor and Francis
This article evaluates whether providing hypothetical or realistic information influences the assessment of decision-making capacity in elderly patients with (and without) cognitive impairment. Decision-making capacity was assessed by means of a clinical vignette that presented a choice about whether to undergo an endoscopic procedure. The following standards of decision-making capacity were evaluated quantitatively and qualitatively: ability to evidence a choice, to understand, to reason, and to appreciate a situation. The vignette was presented to patients in either a hypothetical or real situation. In the hypothetical situation cognitively impaired patients performed significantly poorer than cognitively non-impaired patients on all abilities associated with decision-making capacity (with the exception of evidencing a choice). The realistic situation showed the same pattern among cognitively impaired and non-impaired patients in their ability to understand and in the total vignette score. Both types of patients reasoned about and appreciated the realistic situation equally well. Qualitative analysis revealed that patients gave comparable answers in both hypothetical and realistic situations. The answers were not related to standards of decision-making capacity. Moreover, personal circumstances were taken as a reference point for making a decision, regardless of the situation. We did not find any major differences between the hypothetical and realistic situation. Our findings do raise questions about the validity of hypothetical vignettes, however, especially when used with cognitively impaired persons.
Competence to consent to treatment of geriatric patients: judgements of physicians, family members and the vignette method
- Authors:
- VELLINGA A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(7), July 2004, pp.645-654.
- Publisher:
- Wiley
In absence of a gold standard of methods to assess competence, three judgements of competency of geriatric patients are evaluated: the judgements of a physician, the judgement of a family member, and the judgement of an instrument. Competence of 80 geriatric patients was judged both by a physician and a family member. Decision making capacity was assessed with a vignette. A vignette describes a treatment choice, after which the following abilities are evaluated: evidencing a choice, understanding, reasoning and appreciating a situation. Cognitive functioning was measured with the Mini-Mental State Examination. Most of the geriatric patients were judged competent by all three methods. Disagreement between the three judgements was found for 25 patients. Agreement about incompetence was only reached for one patient. Physicians appeared to be most lenient in their incompetency judgement: only three patients were judged incompetent. These patients scored significantly lower than competent patients on cognitive functioning, the decisional ability of understanding, and the total vignette score. Family members appeared to be most stringent in their judgement: they considered 22 patients incompetent. Incompetent patients scored significantly lower than competent patients on cognitive functioning, reasoning and the total vignette score. The disagreement between the judgements suggests a difference in factors given emphasis by the three methods. The finding that both the judgement of physicians and family members are associated with the assessment of the vignette, suggests that the vignette method has more than a legal theoretical base and is associated with daily life experience and knowledge as well. Physicians can be helped to assess competence by the vignette method to evaluate decisional abilities and by family members who can provide more information about patients' values.
"Choice" in end-of-life decision making researching fact or fiction?
- Authors:
- DROUGHT Theresa S., KOENIG Barbara A.
- Journal article citation:
- Gerontologist, 42(Special Issue III), October 2002, pp.114-128.
- Publisher:
- Oxford University Press
The contribution of bioethics to clinical care at the end of life (EOL) deserves critical scrutiny. Researchers have rarely questioned the normative power of autonomy-based bioethics practices. Research on the ethical dimensions of EOL decision making has focused on an idealized discourse of patient "choice" that requires patients to embrace their dying to receive excellent palliative care. There is little or no empirical evidence to support the autonomy paradigm of patient "choice" in EOL decision making. It is exceedingly difficult to identify, study, and critique normative assumptions without creating them, reproducing them, or obliterating them in the process.
From ritual to relationship: a person-centred approach to consent in qualitative research with older people who have a dementia
- Author:
- DEWING Jan
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 1(2), June 2002, pp.157-171.
- Publisher:
- Sage
Currently, most researchers are not describing how persons with dementia are included in the consent process other than through an extension of the traditional competency-based informed consent method. The article concludes that a revisionist person-centred inclusionary approach to consent, which values the interests of all parties involved, including the person with dementia, is a way forward in person-centred research. It is also suggested that dementia-friendly methods must be more rigorously tested and reported.
Ethics and dementia: mapping the literature by bibliometric analysis
- Authors:
- BALDWIN Clive, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(1), January 2003, pp.41-54.
- Publisher:
- Wiley
This paper reports on a bibliometric analysis of keywords in the literature on ethics and dementia during the period 1980-2000. Keywords were drawn from titles, abstracts and keyword fields of 14 bibliographic databases and clustered in to 19 categories. These categories were then examined for their frequency and co-occurrences. Four categories appear consistently and frequently in the literature: professional care, end-of-life issues, decision-making and treatment. Other issues come and go (such as quality-of-life issues) while others appear to respond to outside events (e.g. feeding issues). The research literature is based predominantly on surveys or studies soliciting responses to predefined issues. Little research has been undertaken to establish the range of ethical issues for either family members or professionals